Membership Application - NORTH DAKOTA PROFESSIONAL GUIDES and OUTFITTERS ASSOCIATION
Please print and fill out by hand or type electronically and then print.  (Please print all entries clearly)

Your Business Name: ____________________________________________________

Species Guided For: _____________________________________________________

Your Name: ____________________________________________________________

Street Address: _________________________________________________________

City: __________________________________________________________________

State: _____________________________Zip:__________________________________

Location of Operation: _____________________________________________________

Phone Number Day: ____________________ Phone Number Night: ________________

Email Address: ___________________________________________________________

Website Address: _________________________________________________________

Signature: _______________________________ Date:___________________________

Membership for Calendar Year(s) ________________ Time starts when funds received.

Membership Dues:     One Year = $20.00      Two Years = $35.00

Website Address on www.ndpgoa.com (Direct Link) = $25.00/Year: Two Years = $45.00

Political Action Fund (for lobbyist activities) voluntary amount: ____________________

Circle One:           Outfitter          Guide

Employers may pay for employees at the rate of $10.00/year, attach information on back.
Please pay in 2 year increments when possible.
Send check or other form of payment to

NDPGOA
9247 Forest Dr.
Bismarck, ND 58503-6537
Att: Jim Schuster

You will be billed 30 days before your membership expires as a reminder.

Thanks for your support

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